Background:
I was a non-believer in insurance, mostly due to the aggressive way it's sold, up until I was 30 years old. Then a friend became a Prudential agent and I bought a medical card to support him, which also included life and critical illness protection, and very minimal investment.

Then I started freelancing and also bought a house and a car, so I thought of increasing my insurance - in case something happened to me, the insurance would pay off the loans. Still having doubts about the ethics of insurance companies, I decided to buy extra life and critical illness protection from Great Eastern this time to "diversify the risk".

Over the years, I increased my insurance protection and also bought insurance, including a 15-year education savings which I regret, for my 2 sons. I also started a company that grew to almost 100 people and have been buying company group insurance from Great Eastern - paying a premium of about MYR 70,000 a year.


Critical Illness:
Last year, I was diagnosed with a heart condition that was covered under the critical illness insurance. Due to my fitness level, I was able to undergo non-invasive keyhole surgery (more advanced, less painful, recover faster, smaller scar) to repair my heart, instead of the conventional open-heart surgery where they saw your chest bone and open up your chest.


Claims:
Upon discharge, I submitted all the neccessary reports and documents to both agents and on the SAME DAY. This was what happened:

Prudential
- the agent told me Prudential will respond within 14 working days.
- within that period, Prudential sent me an SMS saying the claim was successful.
- the money was paid into my bank account 2 days later.

Great Eastern
- the agent said don't know how long the process will take.
- a week later GE asked for "certified" docs, which were copied and submitted by their own agent.
- a week later, I was asked to complete a questionnnaire, including which other insurance company I bought from.
- then my claim got rejected.
- GE says based on the policy, I MUST undergo an open-chest surgery to qualify.

My agent was stunned and my cardiologist literally said "what the fuck?". My agent appealed and got rejected - twice. Finally, I wrote a long email to express my disappointment and detailed my entire journey with GE, comparing it with Prudential. My email was escalated two levels up ...and then NO REPLY for a whole month.

Then my surgeon wrote another report and appealed to them. Finally, my claim was approved but GE proudly emphasized that they were ONLY doing it out of goodwill.

I promptly terminated and switched my company group insurance to Prudential. I also did the same with my son's insurance.


Buyer Beware:
It's companies like GE the reason why I never trusted insurance companies. Even my insurance agent who had been selling GE for 13 years was unaware of such a clause, hidden in the fine print.

The insurance policies are supposed to cover us until 100 years old. So between now and then, if there's a new and more advanced medical treatment, we still can't use it because it's not covered under GE's archaic policy?

Over the 13 years, my insurance agent has sold over 500 policies. But including mine, he has only made 3 CLAIMS for critical illness/life to date!

Other issues that I had with GE, was with their online access which didn't work and customer support which takes a minimum of 3 business days to respond, e.g. "we will transfer your request to the relevant department". Seriously? In this day and age of Internet speed? In my last interaction with them, they took 1.5 MONTHS to reply "due to sudden surge of volumes of email" (I wonder why), by which time I'd totally given up.


Conclusion:
Be careful when buying insurance - it's easy to buy but difficult to claim. Based on my personal experience, I would highly recommend Prudential instead (for now). The PruWaiver that I bought meant my son's premium will now be borne by Prudential. My premium will also be borne by them and paid towards my cash value until my policy expires at 100 years old.

That's also how I was sold. But there are many hidden clauses which we're unaware of. E.g. both insurance rejected my claim last year because they said based on the policy, I have to undergo first, to file for claim - not upon diagnosis.

Thanks. I'm recovering well.

Medical is much easier and I think life too - because there's not much to dispute if you die. It's critical illness that's difficult to claim.

Good for now at least. I hear they are easy on the approvals - not sure if it's because they're trying to grow aggressively. My medical claims were also smooth and quick.

How many of us are actually given the opportunity to go through the entire document before we sign? It's the same in Malaysia for SPA, will, loan agreements, etc.

I believe you're referring to medical insurance. My problem with GE was for critical illness insurance.

Think mine's called Living Assurance policy.

Another interesting thing to share is that I paid about MYR 90K in total premiums for the 2 Prudential medical cards (which included life & critical illness) over 15 years.

My cash value rose to MYR 53K last month and I managed to withdraw MYR 40K.

My two medical cards were purchased in 2004 and 2012 respectively.

I did not go for heart bypass. Mine's valve repair via keyhole surgery for mitral valve prolapse.

And that's precisely my point... how can you sell a policy that's supposed to last for 60 years but limit the methods used to out-dated treatments? The surgeon obviously chose keyhole surgery because it's the more advanced method. And acccording to my cardiologists, only 2 hospitals have such experienced surgeons - IJN and Universiti Hospital.

Should the insurance company ethically define the method used? They're after all an insurer and not medical consultants.

I bet most agents still sell critical illness cover as "we'll pay if you get any one of the 36 or 42 critical illnesses", right? They don't say "only after treatment and only if you used specific methods". If you disclosed this, do you think your customers will buy the insurance?

1. With or without the insurance, I will still have to do the surgery anyway.

2. It's not a panel hospital, so I'm not sure if they'd do that. My agent told me to pay first, claim later.

3. This is for critical illness claim, not medical insurance claim.

The industry is flawed. Instead of helping customers in the time of need, they seem to be greedy and focused on profit, judging by the products and fine prints. Even using agents who have targets and earn solely based on commissions, do we realistically think every agent is going to be honest and ethical?

Referring to my initial post where I mentioned I regret buying the education savings plan for my son, the agent who sold me guaranteed the returns. The new agent told me he never promotes that product to his customers because the returns are very low.

Nope. I'm supposed to pay for 10 years (paid 9.5 years already) but only earn interest from 11th to 15th year. After paying more than MYR 100K, the cash value I can withdraw is less than what I've paid - I would've been better off even putting in FD.

He advised to buy unit trust.

Absolutely untrue. It's like cancer is cancer, regardless of whether it's treated with chemo, radio or surgery.

Mitral valve prolapse is listed as one of the illnesses. That should be all that matter.

That's how we were all sold the policy but it's clearly not the case. Hence, the point of this post to create awareness.

Think they meant they'll only cover when the policy is in effect, which of course it was.

My payments are all on auto-debit from my credit card.

About MYR 60K. Note that Universiti Hospital is only semi-private.

It was a bad investment. If I'd put 12K every year into FD for 10 years, I would've seen some nice growth. Instead, I'm now in negative.

The chamber in my heart swelled by 20% in 9 months. The 3 cardiologists and 1 surgeon I saw, estimated I had 6 months at most before the heart started to fail.

My surgery took 6 hours. The heart was stopped and my lungs collapsed. After that I was in ICU for 5 days.

Was GE therefore reasonable with the t&c? Just because it wasn't open-chest surgery, therefore it wasn't critical enough?

Put it this way, my cardiologist who lectures, publishes and also featured in the newspapers reacted with "what the fu*k?"

P/S: I dislike seeing doctors and I've never made a single claim on my insurance since 2004 until now.

This post has been edited by wirelessdude: Sep 9 2019, 11:07 PM

1. Nope, AFAIK, you can only claim from one. I only have medical coverage with Prudential.

2. Nope, I think medical insurance is worth buying and highly recommended (make sure you buy the waiver too) because the claim is more straightforward. There are fewer T&Cs like certain things not claimable (e.g. consumables, admin fee, etc) and can only claim if xx days before/after the surgery (e.g. my 6-monthly follow-up echo scans will not be claimable).

The total cost at a semi-private hospital is already MYR 60+K; I won't be surprised if it cost MYR 100+K in a fully-private hospital. I read somewhere else on LYF where this guy says he doesn't need medical insurance because he can go to public hospitals. For those which such perception, I urge you to pay a visit to hospitals like HKL and see for yourself first.

However, for critical/life insurance (considering the amount of caveats), I may not buy it on hindsight.

If you look at my medical insurance from a "financial" perspective (approx. values):

Total premium paid = MYR 90,420

What I got/will get in return:
1. Medical claims = MYR 65,000
2. Critical illness = MYR 295,000
3. Cash Value = MYR 53,000
4. Waiver on my policy (up to 100 yrs old) = MYR 409,000*
5. Waiver on my son's policy = MYR 12,000

Total returns = MYR 834,000
ROI = 9.2x

*excluding investment returns.

I hope this thread will help Malaysians make a more informed decision on your insurance needs. Do not believe everything you're sold and do not buy more than you should.

P/S: PM me if you want the contact for my Prudential agent. He's a young, honest and hardworking boy whom I can trust and recommend. He takes care of both my personal and my company's group insurance.

Generally, yes and also depends on which hospital, surgeon and how many opinions you get.
- I had opinions from 3 different cardiologists, who had no vested interest in my surgery.
- the hospital I went to is semi-private.
- my surgeon is an academic.
- of the MYR 50+K surgery cost, my surgeon's fee was only MYR 9+K.

This post has been edited by wirelessdude: Sep 10 2019, 10:30 AM